Anterior Cruciate Ligament (ACL) Tears: ACL Repair Using a Suture Implant Animation

Anterior Cruciate Ligament (ACL) Tears: ACL Repair Using a Suture Implant Animation

This animation demonstrates an ACL repair for the treatment of an ACL tear. When an ACL tear is closer to where the top of the ligament attaches to the femur, or thigh bone, it can be repaired by being reattached to the bone. In cases where the ACL tears farther down the ligament, the ACL often needs to be reconstructed with a tendon graft.

Here, we see inside a right knee with the ACL torn off from the thigh bone. First, a pin is drilled into the location where the ACL was attached to create a tunnel through the bone. A blue and white looped suture is passed through the tunnel and tied out of the way for now.

Next, a passing suture implant is placed through the top of the ACL with a suture-passing instrument. After it is pulled tight, it creates a luggage tag ring around the ACL. The end of the suture is cut off, leaving 2 free ends. Next, the ACL is prepared with an adjustable suture device from a product card. The #1 suture from the card is threaded through the opening in the passing suture end. The other passing suture end is pulled to pass the #1 suture into the knee through the luggage tag ring and back out.

The striped suture is cut, leaving the white loop. Then, the #2 suture from the card is removed, passed through the #1 suture loop, and then back through the metal loop on the card, which is attached to the blue tab on top. The blue tab is pulled, and the #2 suture is pulled up to thread the sutures through the adjustable suture device. You can see here that a double loop has now been created and is passed through the suture in the ACL.

All of the sutures from the adjustable suture device are removed from the card. These sutures contain a small metal button that will sit outside the thigh bone and flat support sutures that can be used to support the ACL. Next, a pin is drilled up through the tibia, or shinbone, to create a tunnel. There is a needle inside the pin that is removed, and a wire loop is inserted through the pin. It is moved out of the way for now.

The sutures from the adjustable suture device are threaded through the blue and white looped suture that was placed in the thigh bone earlier, which is used to pass the sutures into the tunnel. The metal button is pulled out of the tunnel and flipped out to sit on the outside of the thigh bone. The white tensioning sutures are pulled one at a time to tighten the ACL tissue back to the thigh bone.

The flat support sutures are threaded through the wire loop that was placed through the shinbone and pulled through the tunnel. A small hole is made in the front of the shinbone, and the ends of the support sutures are tacked down with a hard-body anchor. The tensioning sutures will be tightened once more, and the ACL repair is now complete.